Worse Than The Disease

The child's body turns rigid, the eyes roll back, and the limbs begin to jerk. These are the frightening signs of a febrile seizure. Triggered by a high fever, often during an infectious illness such as tonsillitis or flu, this type of convulsion is caused by violent nerve storms in the brain. About 130,000 of the 4 million children born each year in the U.S. will have at least one febrile seizure by the time they turn seven.

To prevent additional seizures and satisfy worried parents, physicians often prescribe phenobarbital. But according to a report in last week's New England Journal of Medicine, the drug may do more harm than good. In a study of 217 children from eight months to three years of age who had had at least one seizure, researchers at the University of Washington and the National Institutes of Health found that children who took phenobarbital daily for up to two years had significantly lower IQ scores than those who were given a placebo. Some difference was still apparent several months after they stopped taking the drug, but it is not known whether the impact will be permanent. To make matters worse, phenobarbital was not effective in suppressing seizures.

Since most febrile seizures are scary but harmless, researchers say, there is little reason ever to use phenobarbital as a treatment. About one-third of all the children who have these convulsions are likely to have subsequent ones, but only 4% eventually develop epilepsy.

Phenobarbital was once widely prescribed as a sleeping pill, and is still used by epileptics of all ages, but its impact on the intelligence of adults is not known. Despite the new evidence against phenobarbital, people taking the drug should not stop without consulting a doctor. As with any anticonvulsant, going cold turkey may trigger severe seizures.